India was/India is

December was another month littered with travel. From Mumbai to Delhi, Delhi to Mumbai, Mumbai to Varanasi, Varanasi to Delhi, and finally from Delhi to Singapore, I can only hope that my refusal to eat meat will continue to counterbalance my existential distress over my carbon footprint. 

I’ve delayed writing this post for a while. It’s not been for lack of activity nor lack of stimulation. In the time since I penned the last update, I’ve shadowed a pediatric palliative care unit in Mumbai for a few weeks, attended a conference about the future of public health, travelled to Varanasi, and celebrated the holidays. 

There are actually numerous drafts of this post saved to my computer, each of which I scrapped for one reason or another—too much focus on the work, too much focus on my personal experience; too meandering, too pedantic; too much, too little. 

Writing has always been an outlet for me, a means for creation when comprehension fails. There’s a lot about India that didn’t make sense to me (many things that, in three months, would’ve been unrealistic for me to completely understand), so I wrote. A lot. However, regardless of how many words I spilled into Microsoft Word, each was spurned for its inability to cohere with the others and accurately convey my experience. 

It wasn’t until late last night as I replayed my memories in the liminal space between wake and sleep, did I realize that my time resists synthesis because it largely existed in fragments. 

India was a place that completely upended my understanding of palliative care. 
India was a place whose chaos and cacophony often left me enervated. 
India was a place that I stayed a month longer than I originally intended.  
India was a place whose current political situation is equally heartbreaking and terrifying.
India was a place where I made friends that continue to inspire me. 
India was a place that pushed my boundaries, that forced me to be more open and understanding. 

India was all of those things, but it also still is. It is a place that is nuanced, layered, and difficult to make sense of; it is a place I that miss. 

A picture of the River Ganges from one of the ghats in Varanasi

I spoke with an American physician who has worked extensively in India a few days after my arrival in September. He offered advice and suggestions for things to do near where I was staying, he also cautioned that the country could be extremely frustrating. Naïve (and nervous), I laughed at that, a reaction which lead him to explain that he’d once read a book about an Australian couple who lived in India for years yet, when boarding the flight back home, flipped the country the bird out of exasperation.

He assured me that he did not flip India the bird, though he’d come close. 

And so, I’ve had trouble writing because as I boarded my plane, I had the simultaneous urge to give India the middle finger and to run off the air bridge, out of the airport, and back to all that I’d started there. 

When comparing palliative care in the UK to Greece I wrote, “If my project in Greece was a matter of trying to locate disparate puzzle pieces to put together a cohesive image, my project in the UK is a matter of looking at a mostly completed puzzle and trying to understand how it was pieced together.” Continuing with the analogy, my project in India was largely a matter forsaking my fluency in puzzles to learn instead how to solve a rubix cube. A rubix cube is not inherently more difficult to solve than a puzzle, though it certainly is if you’ve only ever solved puzzles and have the cube thrusted into your hand with minimal explanation. 

The rules that govern are just different. 

To understand how palliative care is provided to individuals in India, I had to struggle to understand, among many many others things, why palliative care services take such a different shape than elsewhere that I’ve seen, how communal culture impacts medical decision making, why intersections of identity (which dictate, even if only subtlety, how care is provided in most places) really dictate how it is provided in India. 

An interlude before the punchline: the tiny Christmas tree that my friend and I adored with gifts

To be entirely honest, as I write this, I’m still not sure where all of these experiences leave me. I have thought a lot about something a psychologist I shadowed for a while said to me when chatting about the importance of palliative care, “There is not always a cure, but there is always an opportunity to heal.” 

As readers of this blog will know, the last two posts have struggled with the realizations that: (1) we all generally want the same things—to love, to be loved, to feel valued, to be free of pain and (2) that experiences, particularly unfamiliar or overwhelming ones, can be made manageable, easy even, when we are met with kindness and compassion. I’ve wondered out loud if I really needed a trip around the world to realize those things; to conclude at the halfway mark of the most immense opportunity of my life that we just need to do a better job being beings felt a little unsatisfactory. 

In my last few days in India, as I allowed a bit of time for rest over the holidays, I began to think differently. Rather than accusatorially asking myself ‘did I really need a trip around the world to realize those things,’ I began to question ‘why has a trip around the world spurred those realizations?’

I now wonder if this trip around the world has spurred these realizations because it’s the first time there’s been no pressure for an answer or a cure, no pressure to immediately understand all that is in front of me. Instead, it’s the first time I’ve been able to think deeply about curing’s elusive and enduring cousin, healing.

In some ways I’ve always been aware of the omnipresent opportunity for healing—intellectually, theoretically—but now I know it differently, know it as a part of my constitution rather than my consciousness. India, I believe, is largely to thank for that. 

I am spending a few days in Singapore for a short vacation before heading onward to New Zealand where I will be based through March. 

(Not so) Peripatetic Palliation

I have been based in Trivandrum, India since the last update. It has been three weeks since I arrived, marking the longest that I’ve stayed in one place since beginning my Watson exactly 101 (!!!) days ago. 

It feels like it’s been forever since I’ve written, and that’s because in some ways it has been. 

I wrote my last update from London, drafting the post in a swath of hostel common rooms while inevitably sipping some sort of bitter black tea. Now, half a world away from all of that, I write this update from India, having drafted this entire post in intermittent bursts seated in the same spot while pondering why tea tastes so much better on this side of Dubai (the sugar!).

It’s been about three weeks since I arrived and started working with my current organization, the longest amount of time I’ve had a semblance of routine since beginning this journey some three months ago. When crafting my Watson proposal, most of the research I did about palliative care in India seemed to point back towards one organization: Pallium India. At the time, I sent them an email expressing my interest in learning from them, they responded by indicating their receptiveness and experience with international visitors. Life worked its mysterious wonder and exactly a year after initial contact with Pallium, I was sitting inside of its Trivandrum office.

Pallium India is located in the state of Kerala in the south of the country. For many reasons that I will not list here, Kerala is quite different from the rest of India, so much so that some have jokingly welcomed me to the ‘Country of Kerala.’ It’s estimated that less than 2% of patients in need of palliative care in India actually receive it, but Kerala, a state with 3% of the country’s total population, boasts over 90% of all palliative care programs in the country (1). Even though I was aware my exposure to palliative care in this southern state would be far from a representative sample, I was interested in learning more about what has been dubbed ‘The Kerala Model,’ a model of development characterized by the creation of a strong social infrastructure, and particularly its impact on palliative care development (2). (Over)Simply put, as it applies to palliative care, the main components of this approach rely on community mobilization and engagement, involvement of local self-government institutions, and attempts to incorporate palliative care into primary care.

Having accommodated so many international clinicians in the past, it’s often assumed that I am a doctor or a nurse even though I am quite far from either. Since being a Watson Fellow is not necessarily something that can be described succinctly, I’ve settled on saying that I am studying palliative care anthropologically. It’s not entirely true, and I take some issue with the label, but it’s the most accurate way to describe what I’m doing quickly.

Perhaps that raises the question: what have I been doing? For the better part of three weeks, I’ve been learning as much as I can from the folks here. I’ve joined clinical teams on home visits, went for rounds on the inpatient unit, and interviewed just about every person working in or around the organization. Prior to arriving, I had read enough about their model of delivering care to understand how the proverbial machine worked, so I endeavored to use my time here to learn how all the pieces and parts come to function in unison.

A picture of one of the Pallium India home care vans I took during a day of home visits.

After all I’ve learned here, I may be better off asking ‘What isn’t palliative care?’ than ‘What is palliative care?’ A 2017 Lancet Commission Report describes palliative care well through one of the five key messages it identified for global access to palliative care and pain relief, “Alleviation of the burden of pain, suffering, and severe distress associated with life-threatening or life-limiting health conditions and with end of life is a global health and equity imperative” (3). Notice in this definition that both life-threatening and life-limiting health conditions are separately acknowledged. 

Recently when talking about my work, someone affiliated with Pallium asked, “When speaking about your project, you mention palliative care and death, so which is it about?” A few months prior I think I would have quickly come up with an answer that may have made it seem like the overlap was entirely intentional and very well-reasoned. Instead, I answered honestly, “You know, I sometimes have to laugh at myself because I confused end-of-life care and palliative care in my proposal, using the two synonymously when really they are quite distinct. I think there is a tendency to confuse, and I am guilty as charged.”

Watson has made me bolder, more willing to be vulnerable.

It common to confuse palliative care with end-of-life care, and astute observers will notice that I have here at times. I am far from alone in doing so. Even as someone who worked in a department of palliative care for two years, my conflation is largely subconscious. True that illnesses which are life-limited are often also life-threatening, but to assume that palliative care should only be available to that subset of individuals is to deny many more much needed care. I hypothesize that this occurs because in countries like the US, where for most people (but certainly not all) aspects of life that may be impacted by illness such as employment, education, and rehabilitation needs are taken care of by established support systems, the services rendered under the guise of palliative care may only be needed at the when facing the end stages of a life-threatening illness. It can also be argued that there is just not enough awareness or development of palliative care provisioning to have the field understood as holistically as it endeavors to be. Either way, it was an Indian palliative care physician who recently told me that he had to help lobby tirelessly to make sure the language surrounding palliative care included both life-threatening and life-limiting health conditions, explaining that “clinicians from other countries just have not seen the scale of suffering here.”

It is tempting to write an entire post delving into just that, exploring the heartbreaking magnitude of need that I have witnessed. Certainly, it would be an appeal to pathos, and perhaps because of that the most effective way of convincing others of the importance of palliative care. Yet, I have always felt a great reticence in showcasing any suffering that is not my own. Instead, I will describe one of my most impactful experiences I’ve had on my year thus far:

I am on a home visit and see a woman with a stomach tumor so large I initially thought she was pregnant. Despite the rural location of their home and the financial constraints under which they live, she’s been to a number of hospitals and had a number of procedures done. I don’t speak a word of the language, but I don’t need to in order to sense how much distress she and her family are under. The clinical team rushes around me; I can’t take my eyes off of her. All I can think is ‘I am here with you,’ then do my best to allow every part of myself to be in those moments with her. I can feel the tears welling—are they mine or hers? I can’t be sure. I don’t cry, but as I leave, I met her eyes giving a soft smile and a small nod. 

Did I make any difference? I don’t know, but no longer think ‘making a difference’ is what really matters. I think what matters is being a human; is embracing all of the pain, the tragedy, and the joy that comes with it; is being unafraid to touch others with our humanity and to allow ourselves to be touched theirs. 

I decided to extend my stay with Pallium India for another week, meaning I will be based in Trivandrum until nearly the end of the month. With this extra time, I’ve been working on a social media campaign for the organization that will form the substance of the next update to this blog. 

(1) “Models of delivering palliative and end-of-life care in India.” Suresh Kumar, 2013. https://pdfs.semanticscholar.org/3fe1/388e88d07934f1215a33cb79fd206d914545.pdfd

(2) More can be read about the Kerala Model can be found in this article: “Growth and Success in Kerala.” Alexandra Brown, 2013. The Yale Review of International Studies.

(3) “Alleviating the access abyss in palliative care and pain relief-an imperative of universal health coverage: the Lancet Commission report.” https://www.ncbi.nlm.nih.gov/pubmed/29032993

Navigating the Valley

Since arriving in the UK, I’ve spent time in London, Bath, and Dorset County.  

My time in the United Kingdom can be best described as a whirlwind. Before I’d even stepped off of my flight at London Heathrow three weeks ago, I knew a shifting of gears would be necessary. Rather than arriving and immediately navigating to an unknown place to be greet by strangers, I headed directly to a house rented by my grandparents who would be visiting for about a week. No scrounging for dinner or awkward small talk upon this arrival—just the pile of clothes from home and known faces. 

Transitioning to the UK also marked a significant change for my project. Unlike Greece which is in the preliminary stages of palliative care development, the UK is the birthplace of many of the ideas integral to palliative care as commonly understood. If my project in Greece was a matter of trying to locate disparate puzzle pieces to put together a cohesive image, my project in the UK is a matter of looking at a mostly completed puzzle and trying to understand how it was pieced together. 

Ostensibly, this makes my work here ‘easier.’ In reality, I’ve struggled to navigate as I’ve felt pulled in many directions.

To put it into perspective just how many ways I could have taken my project in the UK, here is a list of all that I have done while here: 

  • Attended…
    • A Death Café 
    • The garden of a hospice for its open afternoon 
    • A poetry event put on by a public health commission 
    • Two conferences
  • Spoken with…
    • A poet who works with individuals with dementia and their caregivers 
    • Academics who work at the intersection of death and either art, humanities, philosophy, or education 
    • More than a handful of clinicians—doctors, social workers, etc. 
    • The fundraising and marketing team of a hospice 
    • Many more who I am forgetting to include 
  • Participated in…
    • A one-day conference on broadening the LGBT Health Care agenda 
    • A four-day conference on the social context of death, dying, and disposal 
    • A poetry workshop 
    • The Summer Fete of a hospice organization—both as a volunteer and attendee 
  • Plan to (in the few days before I leave)…
    • Interview individuals about the foundations of the Death Café movement 
    • Spend an afternoon with an author who is writing a book about death festivals 
    • Be given a tour and a chance to interview folks at the oldest hospice in the UK 
    • Enjoy the last bits of cooler weather that I’ll feel until I return to Europe in March 
  • Been struck by…
    • A cold! My first this year which kept me in bed for two full days
    • The first ‘valley’ of this experience 

Things have been… crazy. Though the list above may make it hard to believe, I’ve regretfully had to turn down a number of opportunities. I’ve struggled to write this due to the sheer amount of learning that has taken place in such a short amount of time. I could write an entire blog about all of my experiences over the past three weeks, but instead I am going to take this one in a different, more personal direction: the first ‘valley.’ 

Before that, here’s a touristy photo I took outside of Windsor Castle while with my grandparents

In the time leading up to the Watson, when people would ask me how I felt about the impending journey, I would overconfidently assure that it would be a series of ‘peaks and valleys.’ If I could keep sight of that, I would be okay. 

I’d been keeping sight of it, but now I’ve also lived it. 

Greece was an extended peak. The country is gorgeous, organizations were very willing to accommodate my work, I quickly made friends. It was the perfect place to start this trip—just different enough to force me to stretch, yet similar enough that I could relish in familiarity when needed. My time there bolstered my confidence in a big way. 

Then came London. 

You wouldn’t expect London—with American creatures comforts and its resemblance to Boston—to be the place where I first floundered. Oh, but floundered I did. 

I really can’t explain how it all unraveled. Maybe it was seeing my family for the first since I started the trip, maybe I was a bit too ambitious scheduling six straight days of conferences immediately after five straight days of ‘vacation’ immediately after making my first country change, maybe I should have been more deliberate in choosing a direction to take my project beforehand rather than figuring it out upon arrival. It was likely a mix of all of those things, but all I really know is that I spent a few days walking around with two main thoughts: (1) how can I sustain this for nine more months?; (2) what would happen if, on July 1, 2020, I returned to the Boston Logan International Airport, laid on the ground, and never got up? 

My two thoughts were irrational (though imagining the second often made me laugh), and I recognized in the moment that they were an indication that I was in one of the inevitable lows that this year would bring. There are so many ‘maybes’ that may have contributed, though instead here I am going to focus on what got me out of the low.  

I had previously scheduled myself to spend the week down in Dorset county, a coastal region of country renowned for its natural beauty. In Dorset, I would learn from a poet who hosts workshops for individuals with dementia and their caregivers, and then spend two days with individuals at the Weldmar Hospicecare Trust—one interviewing with people from their marketing, fundraising, and operations teams, the other volunteering at their annual Summer Fete. 

Since poetry, marketing, and fundraising are not worlds that I typically spend much time in, I was excited to see how they may enrich my project. Admittedly, I was also anxious to leave London. The city, while endlessly fascinating and always buzzing, enervated me.

Dorset, however, was the perfect antidote. Looking down different project-related avenues awoke a sense of curiosity whilst my understanding of my project and its boundaries expanded. I was also inspired by the sense of purpose and community palpable in Dorset County surrounding Weldmar. 

As I’ve come to learn, many hospices in the UK are funded dually by state and charitable contributions. Both are important sources of funding, though money from the charitable contributions is more versatile, allowing the hospice to provide services such as art therapy or day centers with social activities. The more funding that is brought in through charitable contributions, the more ‘value-added’ type activities the hospice can provide. Hospices also serve a particular area, only admitting patients who live in that region or have a GP that practices within in it. This puts the hospices in an interesting position: in order to provide all of the ‘value-added’ services (which can and do make a big difference), they need to be well-supported by the community; in order for the community to support the hospice, they must know about it, believe it its mission, and not just see it as a ‘death house;’ in order for community members to believe in the hospice, the hospice must be highly visible and rely on word of mouth praise regarding its service.

If that seems confusing, it’s because it is. I’ve interviewed many people that work in the field and still feel like my understanding is shaky. Put simply (and over generally) it means that hospices often need to put on events that make them visible to the public and raise money. One such event is Weldmar’s annual Summer Fete, where I was set to volunteer. Held at Weldmar’s hospice house, this traditional English Summer Fete comes complete with carnival-like games, music, and a grassy yard full of stalls selling various items. The atmosphere was completely jovial, my time there even more so. I spent the day chasing after balls from the Coconut Shy game where I was stationed with a new thought populating my consciousness, “This is the exact sort of atmosphere you’d want surrounding a hospice, and exactly where I needed to be.”

It’s difficult for me to put into words what exactly about my time in Dorset and with Weldmar changed my perspective. Certainly it was important for me to give time to time to get through the low. The closest I can come to explaining it is through acknowledging how special it is to be a part of something that is not only believed in by the community, but also believes in the community.

Upon returning to London from Dorset, I felt reinvigorated. I am grateful for this short amount of time in the UK; for all it has afforded me, personally and intellectually. It’s because of experiences like mine here that I am learning to look in the unexpected places. To trust the voice inside me that nudges, “open yourself and this will open to you.” 

The sky literally did open to me during one of the walks I took along the coast in Dorset county. It was a profound moment for me.

On Thursday I fly to India where I will be based through late November. Amazingly, I am about a quarter of the way through this year.  

Dignity, Guilt, and Google Maps

Since the last update, I’ve settled in the town of Mytilene on the island Lesvos to complete some volunteer work.

I purposefully booked my accommodation in Mytilene because it boasted a central location, pristine sea views, and plentiful terrace space. The pictures of the place confirmed that I’d indeed be able to drink a morning coffee while admiring the Turkish coastline; Google Maps confirmed that was a mere two kilometers from the town center. I finalized the reservation without hesitation. 

This is not another post about the existential distress I feel as a result of Airbnb (though an entire post could be dedicated to the complicated, often slum-like housing market that sprouted to accommodate the influx of short-term volunteers on Lesvos), instead this will be a post about dignity, about not checking the elevation change feature on Google Maps, and about guilt.

Where to begin? 

First, with a picture from the beach ~5 minutes from my home. The landmass near the horizon is Turkey.

Since winning the Watson, I knew that I would want to take time in each country for a bit of volunteer work. Growing up in the heyday of the ‘Cleveland Renaissance,’ I was indoctrinated to believe that places change when people change them, for better or for worse. I am not naive (nor arrogant) enough to think that a week or two of volunteering will profoundly alter a place that barely spend fortnight in, but I do see the importance of dedicating time, even if only a little, to a greater good. 

I am spending a little over two weeks volunteering with an organization that coordinates yoga and sport activities for refugees. All yoga takes place in the ‘Yoga Shed,’ a rectangular structure with an exposed frame of cylindrical metal pipes shaded with a tarp roof, while many of the sports take place in an old warehouse retrofitted with mismatched foam play mat tiles and handmade, plywood storage units for the clothes and equipment that are borrowed for each class. My role involves providing support to the long-term teachers here. Some days that means partaking in a women’s yoga class, other days a men’s muy thai, and, every so often, providing babysitting services so mothers may fully enjoy the experience of a class. One of the organization’s main goals is to dignify individuals who live under the indignant conditions of the camps here. Though I certainly prefer assisting with deep breathing to serving as a punching bag in muy thai, in each class I witness this goal being fulfilled as the number one rule (‘Have Fun’) is diligently obeyed. 

Any glance at the front page of a major newspaper will reveal a blindness to the indignity rampant in refugee camps (or detention centers in the US), but our reaction to an ill-fated diagnosis received by a loved one confirms that this blindness is only partial. Throughout my time here, I’ve come to believe that dignity is related to value, and that one of the greatest ways to help dignify another is through showing them that they are valued (certainly, the opinions and actions of others are not needed to cultivate a personal sense of dignity, though I believe they can be quite influential in doing so). Outside of the work done by NGOs, for refugees, the bottom rung of Maslow’s hierarchy is, at best, only sloppily guaranteed—a direct reflection of how little they are valued in the eyes of the state. However, when a loved one is diagnosed with a serious illness, the inclination is often to drop everything and play our part in the epic drama of navigating medical institutions, coordinating treatment, and providing support. We show our belief in the other’s value by happily serving as a personal Uber, DoorDash, or TalkSpace service.   

The relationship between dignity and value helped to resolve a paradox that has emerged in my research. Many individuals in Greece have told me that a good death would be a sudden one, yet many more have also told me that it is important to ‘do everything to delay death.’ If the goal is to die suddenly, I’ve wondered why everything should be done to extend life. When I’ve probed as to why the sudden death is the preferable one, the answer has almost always been so as to avoid suffering. The rigors of treatments involved with ‘doing everything’ are seldom synonymous with alleviating suffering, ergo the paradox continues. After pondering this seeming incongruency, it occurred to me that ‘doing everything’ may be a way of showing someone they are valued. A way of affirming that their longevity should follow lockstep with the impact they’ve had on our hearts, even if it means undergoing treatments or procedures that assure against a sudden, or ‘good,’ death.  

Organizations involved with spreading awareness about palliative care often work to revise the notion that valuing an individual involves bestowing things with a perceived high value upon them (expensive treatments, endless tests, a myriad of consultations with all of the ‘best’ clinicians). Instead, these organizations promote the idea that individuals can also be valued when we do our best to preserve the things that they value. Some individual can, and do, value receiving intensive treatment to delay their illness, though many more place the greatest value on maintain a high quality of life, however that may be defined. 

Altering this perception of value may seem simple, intuitive even, but rewiring cultural thinking about value and dignity is a task rife with Sisyphusian frustration. At the end of the day, I think that most people simply want to believe that they did the best that they could to honor their loved one. For Greeks, I’ve often heard that many feel it is their duty to take care of their parents in old age as repayment for the care they were provided as a child. The dedication with which this duty is approached is truly astonishing—I’ve anecdotally heard of individuals who, for many years, paid meticulous attention to osentibly minute details such as room temperature to prevent the worsening of a parent’s condition.

A surefire recipe for languishing guilt is to agonize over whether you did ‘the best’ that you could to dignify another. To me, it seems natural and somewhat hopeful that this is a source of anxiety. Naturally, we all hope that our best was commensurate with the way we valued the other; hopefully, our agony is a sign of how deeply we wanted to communicate that value. Natural and hopeful as it may be, I recognize that languishing guilt is corrosive if held for too long. During my volunteer orientation, one of the experienced coordinators sternly instructed us ‘not to be guilty.’ Undoubtedly, this advice was a result of his own experience with the aftereffects of corrosive guilt. But, even with that advice in mind, in the face of this too-huge world confronted with the too-huge prospects of death and despair, we flounder, we bargain, and we feel immense amounts of guilt. We, or at least I, have the somewhat obsessive inclination to take measure of the uneven cosmic scale: he got cancer, she was born in a war-torn country, they tragically lost their mother; I am healthy, I was born in the US, I am at peace with those I’ve lost. How can this scale ever possibly near balance? 

It is precisely this sort of weighing that the advice to ‘not be guilty’ was targeted towards. Even still, it’s difficult to stop. Often as I walk home, I can’t help but indulge. Though the trip from the bus stop to my accommodation is indeed the promised two kilometers, what was not obvious at the time of booking (because I neglected to look at the terrain change) was a steep, 120-meter elevation gain during the last 800 meters of the walk. While I make my way up the hill—huffing, puffing, often needing to stop and catch my breath—I sometimes have the urge to run. The neighbors and stray cats watch this scene with great confusion: a young, very obviously not Greek girl, already dirtied from a day of sport, makes a beeline up the street whilst her bag thrashes against her back. They probably wonder what I’m doing and, to be honest, I wonder the same thing. Maybe this is my way of dealing with uneven cosmic scales, of trying to communicate the innate value I see in others, of trying to show that I am striving to do the best I can. Or, maybe, this is my way of grappling with not feeling guilty.

A view from the midway point of the hill, taken during one of my walks home in the evening.

I will be spending about one more week in Mytilene before heading back to Athens for a few weeks. In Athens, I will begin to tie up some of the loose ends of the research I’ve been conducting over the summer before partaking in a few festivals near the end of the month.

Goodbyes

The past few weeks of my life have been filled with goodbyes. A necessary part of graduation, each farewell serves as a reminder that my time in the place that I’ve come to know as home now exists in the form of memories and monthly checks to a student loans servicer. Many of these goodbyes have come with a gift that has inevitably fallen into one of three categories: (1) mementos of a shared experience, (2) travel-inspired gifts meant to welcome my coming year, or (3) books about death and dying. An interesting amalgam of my past and future, each gift is a reminder that this chapter is closing while the next is beginning and yet, somewhat paradoxically, the two will be linked by what usually characterizes a final chapter: death. 

Perhaps a bit more explanation is needed to justify what may seem like an otherwise macabre connection. As a Thomas J. Watson Fellow, I’ll be spending one calendar year outside of the United States while pursuing my project, “Dispatches from Death: Exploring How We Die.” Broadly, my project is concerned with the concept of ‘dignified death’ and how it comes to be defined by individuals and medical communities. Topics such access to and provisioning of care at the end of life, meaning-making in serious illness, and the influence of culture/religion/ritual in shaping views about death and dignity all fall under the purview of my project (of which you can read more about here).

My year will officially begin on July 1 when I board a one-way flight to Greece. For now, I’m trying to strike the balance between making plans for the year and allowing it to unfold naturally. One of the gifts that I received (which falls under the category of ‘Travel-Inspired’) reminds that finding the delicate equilibrium between the two will likely be an ongoing challenge. A deck of 75 cards that promises to help “discover the unexpected, wherever your journey leads,” it is designed to make you more appreciative of your surroundings through literal reminders to stop and smell the roses. While shuffling through the cards, I thought that perhaps I should try to guide my days by them, using each as a directive to ensure that I appreciate all of my time. I sometimes fear that the lack of normalcy caused by a year of travel will shift my focus towards attaining a sense of familiarity rather than enjoying the present, so the cards promised the perfect antidote. My momentary resolve was quickly dashed by the realization that I only have enough cards to live every 4.867 days by each one and while intentionally getting lost for one day might be nice, wandering aimlessly for 4.867 days is likely overkill. 

I think my compulsion towards the cards runs deeper than a mere desire to appreciate each day, instead embodying the greater desire to create order amid disarray by attaching significance to certain moments. Attaching significance to my days, through even inconsequential means, allows me to achieve some sort of structure over the time that has passed.

I’ve come to notice the ways in which passing time is counted without clocks or calendars. Some hospice organizations mark the time since a patient passes in phone calls to surviving family members. Calls occur at pre-determined monthly intervals, often until about thirteen months after the patient’s death, though I’m not entirely convinced family members have stopped marking the time since their loved one’s death by the final call, if they ever stop at all. A hospice patient that I was particularly fond of marked her moments by the delivery of the daily newspaper, once telling me that she maintained her subscription mostly to “feel normal.” The daily delivery of the paper was one of the only artifacts from her previous years as a passionate advocate to carry forward into her recent years characterized by stagnation and decline. Each new headline marked another day that she was still unabashedly herself despite existing in a profoundly altered way.

With each goodbye, I’m counting my time towards a year that will be spent exploring how we say goodbye. I’ve struggled in deciding whether to keep a blog, fearing that doing so would be akin to assuming a bully pulpit. I ultimately decided to create one after a friend suggested that the site need not be solely populated with my thoughts and experiences, but could also be a means to share and engage with the experiences and opinions of others. That felt right because even in the months leading up to my year I’ve been overwhelmed by the generosity individuals have shown me in lending their advice, connections, and personal stories. I am humbled by the year ahead of me and the experiences that will inevitably challenge my views of humanity, dignity, health, society, and, crucially, how they all intersect. Thank you for sharing in it with me.